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Harry probably sounds familiar to you, and so do his complaints. It has long been an item of popular wisdom that forty is a difficult age for a man, and an age when he also makes life difficult for others.
You may have seen men like Harry on TV programs about male menopause, or read about them in articles on the same subject. Or perhaps you’ve encountered such men in movies like Scenes from a Marriage and Carnal Knowledge and Save the Tiger; or in books like Joseph Heller’s Something Happened and Alison Lurie’s War Between the Tates.
Maybe Harry reminds you of someone you know—a friend or colleague. Your husband or lover.
Maybe you even feel like Harry yourself.
If not, take another look around you. You’ll discover that a great many men start behaving strangely sometime in the middle of their lives—doing things they never thought they’d do and asking questions they never imagined grown men had to ask. This is the time when careers nosedive, affairs flourish, and marriages flounder or fall apart. Such events are only the tip of the iceberg.
Arriving at the brink of middle age is like being stranded in a foreign country: With few guideposts to direct him, a man feels disoriented by the unfamiliar terrain and the multiple changes jarring his psyche. Suddenly the past seems a humiliating reminder of risks untaken, women unconquered, and chances ignored. And the future seems to be hurtling toward a dreaded rendezvous with old age and death. Meanwhile, responsibilities are mounting and physical energies are ebbing. Children are rebelling or departing, wives becoming assertive and demanding, and parents falling ill or dying. Younger men are scrambling up the work ladder, and job options are shrinking.
With so many altered horizons, a man begins to feel as if he’s lost his focus on things. Outward circumstances and inner stirrings now clash in a new way—-and something disquieting starts happening.
Most of us will recognize the more common symptoms of mid-life turmoil.
This is the time of life, for example, when a man begins to worry about his body. Suddenly he suffers from prostate troubles and pulled muscles. Suddenly he needs glasses or root canal work. His cholesterol count goes up, his energy level down. His body is less reliable on the tennis court, less resilient under stress. He can no longer work such long hours or travel at his usual hectic pace.
He finds it maddening, this loss of control. He feels that his body has betrayed him.
High blood pressure develops and so do ulcers. Psychosomatic illnesses erupt: A man is suddenly beset by chronic fatigue, acute indigestion, mysterious backaches, painful joints, and migraine headaches. He complains a lot or even becomes hypochondriacal, convinced that every cold is the forerunner of pneumonia, every pain the sign of cancer, and every rapid heartbeat the precursor of a coronary.
Often he panics over his sexual performance and suffers from bouts of impotence. He may become lethargic about sex and cut down his activity. Or do just the opposite, pursuing new sexual conquests with a vengeance. He jokes about sex compulsively, develops a sudden interest in X-rated films, or brags outrageously about his exploits.
To confirm his sexual appeal he may try to regain a youthful image by changing his appearance. He grows a beard or mustache, gets his hair styled or dyed. He buys a toupee, undergoes a hair transplant, or gets rid of his wrinkles and jowls by plastic surgery. He may also change his style of dress:
•A conservative executive trades his dark suits and striped ties for velvet jackets and turtlenecks.
•A diffident accountant becomes a weekend hippie, transformed by French jeans, a shirt slit to the navel, and chains around his neck.
•And a quiet dentist switches to suede jumpsuits and platform shoes.
Habits change, too. A man suddenly becomes serious about dieting or exercising. He gets into Transcendental Meditation, Arica, or EST. He gives up smoking cigarettes, tries marijuana instead. A sedentary lawyer becomes a tennis or jogging enthusiast. A teacher takes up skiing or backpacking. And a salesman goes off to shoot the rapids, hunt deer in the wilds, or learn how to pilot a plane.
Sometimes a man makes a wildly impulsive purchase, treating himself to a luxury item he’s dreamed about since youth:
•A newly divorced engineer spends thousands on a racy red sports car, despite his tardiness in meeting alimony payments.
•A computer operator who used to love mountain climbing buys a cabin high in the hills for family weekends, oblivious to the ten-hour drive involved.
•And a store manager who is still struggling to pay off the mortgage on his home splurges on an eighteen-foot cabin cruiser.
This is the time of life when a man often starts behaving in oddly uncharacteristic ways. He ignores his wife and screams at his children. He complains of boredom and fatigue, insisting his life has no meaning. He becomes increasingly detached, withdrawn, and introspective.
He drives himself relentlessly at work, snapping at his colleagues and staying at the office later and later. Or he abruptly loses interest in his job, taking longer lunch hours, forgetting appointments, and dawdling rebelliously over deadlines. The man who was generally calm and easygoing now becomes a demonic whirlwind—always busy, always traveling, always overscheduling himself. Another man, previously cheerful and boisterous, suddenly turns morose and moody. He can’t take a joke anymore, hardly laughs at all.
Weekend patterns change, too. The former sportsman and devoted father now sulks in front of the TV, retreats to his basement workshop, or falls asleep at peculiar hours. When his wife suggests a local movie, or ice skating with the kids, he glares at her reproachfully. And the contemplative man who always relished solitude now fills his weekend with activity—squash, handball, poker, backgammon, anything involving people. Urgently gregarious, he suddenly wants his wife to entertain more, too.
This is also the time of life, as most of us certainly know, when a man is likely to develop lascivious urges. Marriages shake, and sometimes shatter, as men in their forties counter boredom or bickering in the connubial bed with sexual conquests. Suddenly susceptible to erotic adventures, they try everything from intense flirtations to casual liaisons to consuming love affairs. The outcome varies:
•A country preacher refrains from acting on his sexual desires for a young widow with whom he has become enamored. But when he lunches with her weekly he feels terribly guilty nonetheless.
•A timid chemist initiates a furtive affair with his lab assistant, after years of resisting her seductive glances. Six months later he stuns his wife by demanding an immediate divorce.
•A stockbroker begins flirting slyly with the girls in the office, and then graduates to a full-fledged affair with a former high school sweetheart. Unwilling to abandon his children, he settles for a double life instead.
•After years of casual promiscuity, a TV celebrity leaves home because he’s found true love at last. One year later he pleads for a reconciliation, confessing that he misses the kids, the dog, and the Sunday barbeques.
. Whatever the consequences, mid-life infidelities often involve much younger women, in part because the firm flesh and innocent eyes of nubile girls are particularly enticing to men who are anxious to retain their grip on youth. Such romances may be brief and fanciful, just a rejuvenating interlude, or they may deepen and endure. But in recent years it has become increasingly common for men in their forties to remarry a woman many years their junior. Very successful men especially often flaunt a beautiful young wife like another badge of merit. And a symbol of potency. Today such men are more admired than scorned, and we are no longer so shocked as in the past if:
•A publishing executive who claimed his was the perfect marriage leaves home for a copy editor younger than his daughter.
•A television producer who has just bought a lavish apartment suddenly gets divorced to marry a girl who looks exactly like his wife, only twenty years younger.
•And a travel agent who always seemed devoted to his family divorces to marry an ingenue actress he met only two months before.
Newly critical of themselves, their families, and their whole mode of living, men in their forties often entertain dreams of dropping everything—or dropping out. Some fantasize about living in the wilderness, or on a tropical island; others lust for life in a commune, aboard a ship, or on a farm.
\nd then there are those who do more than dream. Rather than simply switching women, they change their goals, their careers, and sometimes their entire way of life:
•Tired of the rat race and urban pressures, a corporate executive gives up his high-paying post and moves his family to a farm in Montana, planning to raise sheep.
•Intent on becoming a commercial illustrator, a mid-western car salesman goes to night school, eagerly anticipating the day he can begin a new career in New York City.
•Fed up with the politics of academic life, a biologist abandons his teaching and sells some stock in order to write the comic novel he has been dabbling with for years.
•And a reporter resigns from his newspaper job so that he and his wife can sail to the Caribbean on the forty-foot schooner they’ve just bought with their life savings.
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What If My Skin Is Sensitive to Light?
Your skin may be extra sensitive to light because
•some chemotherapy causes sun sensitivity that lasts for a few weeks to months after completion of the therapy
•some medications, such as certain antibiotics, cause sun sensitivity
• radiated skin can become extra sensitive to the damaging effects of the sun
What If I Get Many Rashes Now, Although I Never Had Rashes Before?
You may tend to get rashes because of
• current medications
• changes in your immune system from your cancer or cancer treatments that make you react to
yourself
• changes in your immune system from your cancer or cancer treatment that make you more
sensitive to external agents
• emotional nervousness
What Can Cause Skin to Change Color?
Your skin may appear to have a different hue because of
• medication effects
• effects of change in diet
• effects of certain vitamins
• hormonal changes
• radiation effects to exposed area
What If Little Cuts and Bumps Take Long to Heal?
If your skin is more fragile, you may bruise or cut yourself more easily. Bruises and cuts may take longer to heal because of residual changes in your immune system that take months to normalize. In some cases, you are healing as fast as you did before your treatments, but you are more sensitive to changes in your body. Close monitoring of your cuts and bumps makes the healing process seem slow (“A watched pot never boils”).
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Can Anything Be Done to Alleviate My Fatigue If My Doctors Find Nothing Wrong and I Am Following All the Measures Described Above?
With the growth of the population of long-term survivors and with the progress in the prevention and treatment of other problems seen after cancer, such as nausea and malnutrition, the issue of fatigue has moved into the spotlight. Research into its causes, prevention, and treatment is under way. Until answers are found, you must direct your attention to
•correcting all treatable causes (such as anemia, malnutrition, or depression)
• taking steps to prevent problems that cause it
• having your doctors adjust your medications, whenever possible
• developing a healthy daily routine that includes adequate rest
•adjusting to your limitations
Support services can help you adapt and adjust to your fatigue so as to maximize your overall recovery. Loss of energy, like loss of a limb, must be grieved. Adjustments must be made. All of this takes time, energy, and patience.
What Can I Do If My Fatigue Seems out of Proportion to the Treatment I Received or Seems to Be Lasting Too Long?
When fatigue persists, it is common to worry, consciously or unconsciously, that you have cancer again. Remind yourself that many problems other than cancer cause fatigue. In most cases where tests indicate that you are in remission, there is a good explanation other than cancer. Sometimes, however, the fatigue seen in disease-free cancer survivors has no explanation.
Keep your doctor and nurse aware of how you feel, even if your tiredness was addressed before and all treatable causes were ruled out. Although you may feel exactly the same, the explanation may have changed.
One man who was in remission after completing a course of radiation complained of lassitude, feeling cold, getting winded easily, and poor concentration and memory. A complete workup indicated that his thyroid was definitely normal, but he was mildly malnourished. His doctors reassured him that he was experiencing a common aftereffect of radiation in addition to the effects of malnutrition. As the weeks went by, he stuck to a prescribed diet and regained his weight; yet he continued to feel the same. After four months without any improvement, his doctor rechecked his thyroid blood tests; lo and behold, they were low. He had developed hypothyroidism (low thyroid) after the first evaluation, and his symptoms resolved after he took a thyroid medicine for a few weeks. Although he felt the same immediately after completion of his radiation as four months later, the cause of his fatigue was different each time.
Another patient suffered debilitating fatigue following her bone marrow transplant. A complete evaluation showed that she was adjusting well to her situation and was not depressed. Her fatigue was attributed to mild anemia and the physical aftereffects of intensive chemotherapy and radiation therapy. She followed all the advice given to her about diet, exercise, and rest. Over the next year her fatigue became less debilitating but was disturbingly persistent. A reevaluation determined that she had developed significant depression, which was manifesting itself chiefly as fatigue, a not uncommon occurrence after bone marrow transplantation. She responded dramatically to medication and counseling and is now doing beautifully without any medication.
Have your doctor or nurse advise you on specific ways to improve your diet, sleep patterns, exercise schedule, work level, and stress level. Support groups and counselors (social workers, psychologists, etc.) can offer invaluable advice and support in these areas.
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Is It Common to Feel Old Suddenly?
Many of the physical symptoms experienced soon after cancer treatment are similar to those, rightly or wrongly, associated with old age, such as fatigue, decreased mental clarity, increased sleep requirements, and decreased appetite. Many of the insights you have acquired through your experiences may also make you feel older and wiser.
How Can I Transcend Ну Cancer Experience If I Have So Many Physical Reminders?
If you cannot change the physical scars of your experience with cancer, you need to redefine them in such a way that they represent something positive in your life. Cancer survivors can learn to see their physical and emotional scars as badges of courage and accomplishment.
How you feel about your cancer and yourself depends on your state of mind, not body.
What If I Am Anxious about the Health of Myself and My Family?
You have been burned once. You no longer feel safe. You underwent a crisis. You feel that it can happen to someone you love. It is very common to be anxious about your health and that of your family for a while after completing treatment. When you feel well again and have gained some distance from the treatment experience, this anxiety will fade. For some people the anxiety resolves completely. For others it almost resolves but resurfaces easily in the face of any symptom, change, or threat. If this anxiety persists unabated, it must be addressed.
Instead of worrying about how anxious you are, do something about it. Find out quickly whether something is worth worrying about, by getting it checked out. Do not waste your energy trying not to be anxious or worrying that you are being overanxious. You deserve not to have to worry so much. The doctor bills for a problem that turns out to need no treatment may have been avoidable from a medical point of view, but it is worth it for you to be saved some anxiety. If your doctor reassures you that there is no significant problem, be grateful. You cannot know ahead of time which things are going to turn out okay and which are real problems. Remind yourself that you deserve to not worry.
What Can I Do to Be Less Anxious about My Health?
You can take a number of steps to diminish your anxiety about your health:
•Be informed about your follow-ups.
• Know the signs and symptoms for which you should see your doctor.
• Learn about all proven ways to maximize your health and minimize your chance of recurrence.
• Be in tune with your body, recognizing when something is a signal to you that medical
attention is needed.
• Be willing to call your doctor when you suspect that something is wrong.
• Recognize and accept that you cannot control everything. You cannot control every exposure to
food, radiation, additives, pollution, or emotional stress.
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Why Am I So Impatient with My Children?
After a brush with life-threatening illness, you feel that your priorities have been clarified. Grateful for every day and all its gifts, you may regard impatience with your children as a mockery of all that you have learned about life.
There is a logical reason for your impatience. Children live in a self-centered world. Their unending demands and needs are accentuated by their impatience and short attention spans. Their coping mechanisms and priorities are immature, shaping their approach and solutions to problems. It takes energy-requiring insight and patience on your part to understand their viewpoint and respond in a mature, appropriate way.
You, as their parent, are trying to fulfill their basic physical and emotional needs while teaching them the subtleties of morality, patience, and virtue. Teaching children is a tough job under ideal circumstances.
After cancer your physical and emotional stores may be depleted. You may be dealing with your own anxieties and fears, which drain your energy in an unproductive way. You may be irritable and hypersensitive. You may just be overtired. The task of raising your children is waiting for you whether you feel ready or not.
An architect who had completed his cancer treatments was doing well except for fatigue and difficulty in concentrating. Usually soft-spoken yet strict, he found himself being slack on rule enforcement and yelling at his young children every time they whined or cried. He felt guilty that he was too tired to play with them and angry that they were making his life more difficult.
A Mercedes is a good car, but it will not run without gas and oil. This architect was a good dad who needed rest and assistance. His children needed someone who was physically and emotionally able to respond to their needs. Until the dad had the physical and emotional reserves, he had to share his fathering with other adults (friends, child care, relatives).
After resting and receiving emotional support, he was less fatigued and could concentrate better. This allowed him to be sensitive to his children’s needs and respond in a helpful manner. The children were not as frustrated and whined less. He had the energy to reestablish and enforce discipline, which reassured the children.
He required naps for many months after completing his cancer treatments and participated in a support group for years. Taking the time to attend to his own needs enabled him to be a good parent and enjoy quality time with his family.
Who Can Help Me with Ну Children?
There are many resources for help and advice. School teachers, pediatricians, clergy, social workers, psychologists, and child psychiatrists are able to offer experience, knowledge, and energy for coping with your family’s stress as a result of illness. These people can help you prevent problems with your children and pick up problems early. They can help you shoulder the children’s demands for attention and their other emotional needs. And they can be there for you, the parent.
Just as you may have needed assistance with meals and carpooling during your cancer treatments, you may need some help during the months of your recovery after treatments. You may be reluctant to ask for help, because it may be less obvious to others that the need is still there. After all, you are done with treatments. Let friends and family know how they can help. During the transitional months of recovery, it is better for everyone if you use what energy you have in order to be with your children, not to make meals and do laundry.
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